Der Unfallchirurg
-
Humeral head fractures generally may be treated in a non-operative concept with early physiotherapy when fragment dislocation is minor. Dislocated 2-part fractures (head and shaft fragment) may be treated with closed reduction. If the fracture persists unstable, K-wire, cerclage, intramedullary nailing or plate osteosynthesis are the eligible methods. ⋯ In 4-part fractures prosthetic replacement should be considered. Especially when old patients have severe destruction or luxation of the humeral calotte prosthetic treatment may be indicated. Early functional physiotherapy is important after all types of osteosynthesis or prosthesis.
-
Comparative Study
[10-year results of bone marrow stimulating therapy in the treatment of osteochondritis dissecans of the talus].
The optimal operative therapy for the treatment of osteochondritis dissecans tali is still controversial. Beside bone marrow-stimulating techniques like abrasion arthroplasty, drilling and microfracturing, new techniques like autologous osteochondral transplantation and autologous chondrocyte transplantation are increasingly used. This study reviewed the clinical, radiological and subjective long-term outcome of bone marrow-stimulating therapy for 45 ankles with an osteochondritis dissecans tali stage 3 or 4 according to the classification by Berndt and Harty. ⋯ Obesity, age older than 40 years and preoperative osteoarthritic changes had a significant negative impact on the clinical outcome. Bone marrow stimulating therapy is an inexpensive, low invasive therapy and a good therapeutic option at least for small Berndt/Harty stage 3 and 4 ODT lesions. Autologous chondrocyte transplantation and osteochondral autografts yield encouraging 2- and 4-year results, but still have to prove their superiority in long-term follow-up studies.
-
Case Reports
[Aortic valve insufficiency due to rupture of the cusp in a patient with multiple trauma].
Lesions of the heart valve caused by blunt chest trauma is rare, but when it does occur it can significantly injure the patient. On the basis of autopsy studies, research shows that heart valves are injured in less than 5% of patients who have died due to impact thoracic trauma. Among the heart valves, the aortic valve is the most often lacerated, which has been proved by relevant autopsy and clinical studies. ⋯ Seven years later the patient is free of symptoms and is in good physical condition. Echocardiography showed normal dimensions of the heart chambers, a normal thickness of the heart walls, and normal systolic and diastolic function of the left ventricle. Heart valves are morphologically normal, and only an unimportant aortic insufficiency was noticed by echocardiography.
-
Comparative Study
[Femoral neck fractures in the elderly -- bipolar hemiarthroplasty in total hip replacement].
In this study surgical risk and functional outcome of bipolar hemiarthroplasty and total hip replacement in elderly patients with femoral neck fractures were compared. ⋯ In elderly patients with femoral neck fracture and high comorbidity, we recommend the implantation of hemiarthroplasty and in healthy, active patients with longer life expectancy the total hip replacement.
-
Comparative Study
[Quality of life after surgical treatment of osteitis].
Although many studies have measured the functional outcome after surgical treatment of osteomyelitis, there have been few published attempts to evaluate the long-term quality of life. We therefore undertook this study to assess the quality of life in a large patient population after operative treatment for this condition. All patients who underwent operative treatment for osteomyelitis from 1993 until 1997 at our institution were included in the study. ⋯ Compared to a standard population, the investigated patients showed a significant reduction in their overall psychological well being and physical functional capacities. Surgical treatment was able to inactivate the infection in 88% of the patients. Because of persistent deficits, the psychological well being and physical functional capacities are reduced compared to a standard population.